Load Leveling During A Covid-19 Surge: Strategic Redistribution Of Prehospital Pediatric Trauma Patients To Create Capacity In Adult Hospitals
*Romeo C. Ignacio, Jr.1, Candy Schonheit2, Kristi L. Koenig2, Joshua Smith2, Matthew Derkrikorian1, Brandt Sisson3, Tim Fairbanks1, Hariharan Thangarajah1, David Lazar1
1Rady Children's Hospital San Diego, San Diego, CA;2County of San Diego, Health & Human Services Agency, San Diego, CA;3Department of General Surgery, Naval Medical Center San Diego, San Diego, CA
To describe a strategy for load leveling of pediatric trauma patients accessing the 911 system capacity system during a global pandemic.
A complete diversion program (adolescents 15-18 years of age) was temporarily instituted among 21 adult hospitals and one children’s hospital to preserve adult critical healthcare resources. A review of prehospital and ED encounters was performed 30 days pre- and post-implementation of the program. A comparative analysis was completed one year prior utilizing a similar time period. Primary outcomes were the average transfer of care times (ToCT) and delayed ambulances per day (DA/day). Secondary outcomes were confirmed county infections, pediatric trauma transports, and overall pediatric patients diverted to the children’s hospital. Descriptive statistics and paired t-test were performed with a p<0.05.
Although there were decreases in average ambulance ToCT (pre-20.3 minutes, post-17.4 minutes with p=0.0001) and the number of DA/day (pre-5.5 DA/day, post- 4.1 DA/day with p=0.008), the clinical significance remains unknown. There was a marked increase in COVID-19 infections followed by a rise in hospitalizations approximately three weeks later. However, the complete diversion program successfully redirected pediatric patients from adult hospitals to the children’s hospital (Figure 1) with minimal complications.
Conclusions (implications for practice):
A complete diversion program can augment prehospital capacity building, but the relative effect to ED saturation and hospital bed capacity is unknown. Further research is required to determine which measures are more effective for future planning.
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